Patients Are Ready for Sustainable Care: “I’d Like a Green Treatment, Doctor”
What is the environmental impact of surgery? Patients are happy to opt for a more sustainable treatment, provided it is just as effective. But the most sustainable option isn’t always obvious, according to the dissertation by UvA PhD candidate Eva Cohen.
Eva, sustainability in healthcare is a hot topic. Why is that, exactly?
“Globally, healthcare accounts for about 4 percent of total greenhouse gas emissions. In the Netherlands, healthcare accounts for 7 percent of total emissions. That’s roughly the same as emissions from aviation. So a wealthy country like the Netherlands has a responsibility to change that.”
And can that be done without compromising healthcare?
“Absolutely. At Amsterdam UMC, we’re working hard to make the hospital more sustainable. It started in the operating rooms – the most polluting department in the hospital – where my co-supervisor, anesthesiologist Niek Sperna Weiland, founded the first Green Team. Since then, the Center for Sustainable Care has been established, and various measures have been taken to reduce the use of medical supplies; for example, patients no longer wear surgical caps, which saves 44,000 caps per year. And we’re trying to replace disposable products with reusable ones as much as possible. Amsterdam UMC has replaced 100,000 disposable caps annually with 1,000 reusable ones, resulting in a 60 percent reduction in greenhouse gas emissions and a 94 percent reduction in waste.”
“There are now seventy Green Teams at Amsterdam UMC. And more importantly, since 2025, sustainability has formally become part of the organization’s strategy. This means it is no longer dependent on the free time and intrinsic motivation of a few employees, but has become a structural part of policy and healthcare procurement. With this, Amsterdam UMC is leading the way in the Netherlands.”
For your dissertation, you spoke with patients about sustainable healthcare. Is that something they’re looking for?
“There is a lot of support among patients: the majority want more information about sustainable healthcare and believe it’s important to contribute to it themselves. This was also evident from a large study by the Dutch Patient Federation among 9,000 patients: 70 percent indicated they want to factor sustainability into their healthcare choices. Yet, both in the literature and in practice, many assumptions are made that patients do not consider green healthcare important because the effectiveness of care is the top priority. In the conversations I had, it became clear that patients do indeed consider sustainability in healthcare important and are open to information. If they can choose between a sustainable and a less sustainable treatment pathway, where the effectiveness of the care is the same, the sustainable option is preferred. Only in the case of cancer treatments or treatments for their own child did that willingness decrease.”
Can you give an example of a choice for a more sustainable treatment?
“In my dissertation, I examined the environmental impact of two different treatments for myomas (uterine fibroids, ed.), a benign tumor in the uterus. From earlier research by my advisor and Professor of Sustainable Healthcare Wouter Hehenkamp, we know that embolization – partially blocking the blood supply to the uterus – leads to a quality of life just as good as that achieved by completely removing the uterus.”
“While my research shows that the latter has a greater environmental impact in terms of CO2 emissions and waste – an average of 6 kilograms of waste per patient with embolization compared to 9 kilograms of waste with a hysterectomy. These are factors that can be factored into the decision-making process.”
Should doctors then bring this up in the consultation room, is there even time for that?
“The limited time in the consultation room is indeed one of the concerns doctors also mentioned. But information about sustainability can also be disseminated through brochures or campaigns in the hospital. If you really want to incorporate sustainability into treatment options, it must be included in the clinical guidelines, which specify which treatment is recommended based on cost, safety, necessity, and effectiveness. The Dutch Healthcare Institute is currently exploring how sustainability and the deployment of healthcare staff can also be included in that list.”
“Nevertheless, there is still a long way to go. Calculating the environmental impact of care pathways is not yet straightforward. In the case of fibroids, it is still unclear whether embolization actually has the lowest environmental impact in the long term. In fact, 30% of patients who undergo embolization still require a complete hysterectomy after ten years.”
What conclusions can you draw based on this dissertation?
“The greatest environmental impact of hospital care comes from disposable products, patient and healthcare provider travel, and energy consumption by buildings and equipment. That is why one of my recommendations is to reuse all products that can be reused in the hospital. For example, I would like to see us implement reusable surgical gowns and reusable drapes in operating rooms as soon as possible.”
“We can also only achieve a sustainable hospital by working together. So involve the patient in this process as well, but don’t place the entire responsibility on them. Ultimately, sustainable choices should already be made as much as possible before the consultation in the doctor’s office, in consultation with patients, healthcare providers, policymakers, suppliers, and insurers.”
Eva Cohen will defend her dissertation on Friday, June 5, at 10:00 a.m.: Planetary Health Care. Shaping Sustainable Clinical Practice through Environmental Impact Assessment and Patient Engagement. The defense will take place in the Agnietenkapel and is open to the public free of charge.
